Fig. 1.

Comparison of commonly utilized non-invasive tests for coronary artery disease in patients with suspected ischemic heart disease. ACS, acute coronary syndrome; CAC, coronary artery calcium; CTA, computed tomographic angiography; ECG, electrocardiogram; mSv, millisievert; SPECT, single-photon emission computed tomography; U, uncertain. * Per-patient sensitivity and specificity for obstructive coronary artery disease defined as ≥50% coronary luminal narrowing confirmed by invasive coronary angiography according to mean values as reported in current American College of Cardiology Guidelines. Sensitivity for ‘CAC = 0’ derived as the weighted mean from Sarwar et al. [24] and Villines et al. [34••]. # Calendar Year 2012 final Outpatient Prospective Payment System (OPPS)applying procedure codes: Stress ECG (93306), Stress Echo (93351), SPECT (78452), CAC (75571), CCTA (75574), ICA (93458). Note the coverage for coronary artery calcium scanning is limited in many regions. ¶ When follow-up 12-lead ECG and cardiac biomarkers are unremarkable. ^ In patients able to exercise CCTA meets Class IIa indication if patient (a) has continued symptoms with prior normal test findings (b) has inconclusive results from prior exercise or pharmacological stress testing, or (c) is unable to undergo stress with myocardial perfusion imaging or echocardiography